Provider Demographics
NPI:1285066019
Name:BUNNELL, AVIANNE (MD)
Entity type:Individual
Prefix:
First Name:AVIANNE
Middle Name:
Last Name:BUNNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AVIANNE
Other - Middle Name:
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5880 49TH ST N STE 206
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2147
Mailing Address - Country:US
Mailing Address - Phone:727-999-8346
Mailing Address - Fax:877-743-4465
Practice Address - Street 1:5880 49TH ST N STE 206
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2147
Practice Address - Country:US
Practice Address - Phone:727-999-8346
Practice Address - Fax:778-743-4465
Is Sole Proprietor?:No
Enumeration Date:2013-08-03
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1406042086S0129X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery